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  1. #1
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    Help! Nursing or Residential Care Home?

    Hi all,

    Just to update you quickly on my mum and to try and get some desperately needed advice.

    Mum is currently in the geriatric ward of her local hospital (after being brought in last Fri). They have assured me that she will not be released home and a decision about her discharge date won't be made until she has been assessed. (She was taken to hospital after being found on the floor of her flat last Friday. The police had to break the door down as she wasn't answering. She had not let the carer in the day before and we think that she had not eaten for 2 days, hence why whe collapsed...that along with confusion heightened by a UTI).

    My feeling is that mum needs to go into 24 hour care since things weren't working with the private carer who visited each day (mainly because mum didn't always let her in and just wouldn't accept the level of care and help that she needed). Mum is aggressive at times, non compliant with leg dressings for her ulcer (though fine about it now she is in hospital), she has leg oedema (but can walk with a stick), double incontinence (and is not always aware of when to change her pads) and she has been suffering with feinting and subsequent falls and is still fairly weak.

    She is being treated in hospital for a UTI and having her ulcers bandaged each day but my question is whether I should be looking for a nursing home or a residential home once she comes out? No disrespect, but I don't want to put her amongst people who are at a much more advanced stage or dementia as this will crush her mentally I think, but then again, if she is going to get worse, is it better to have her be in a place where there is that facility?

    What is the difference in a residential and a nursing home in terms of a person's care needs? My mum needs lots of help with getting washed, dressed, and although she can feed herself, she does not seem able to go and make the food herself. My mum has brightened up a lot in hospital and was even able to say which floor she was on which amazed me, so I am just not sure what I should be looking for.

    My mum's social worker seems to think that she needs residential care but I am not sure that they will give her the level of care that she needs as I am not sure that it means. I have to wait for the outcome of the assessment at the hospital but I just wanted to be clear of the difference and as we are self funding, the decision ultimately rests with me.

    It is an extremely nerve-wracking time for me as I have a very important decision to make which will affect the rest of my mum's life so i don't want to get it wrong!

    Hope you can help!

    Lisa.
     

  2. #2
    I know exactly what you mean - when I first went looking at homes it was clear to me that nursing homes (and some residential homes) are now full of people who are much further along in their journey than was my mother at the time. I think this is actually a function of the current idea of keeping people in their own homes as long as possible. I got round that by finding an extra care facility which allowed her to have her own flat, on site carers and fast access to the nursing home in the same grounds. For us, it worked out perfectly, although I do know that not all extra care facilities are created equal and some people have had problems with them. So just an idea. I believe there are also some homes which have different floors or wings for people with different levels of care so that might also be an option.
    Jennifer

    Volunteer moderator and former long distance carer.

    “A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.”

    Abraham J. Heschel
     

  3. #3
    Hi Lisa, it is a hard one to call as in most homes some residents will be further advanced than others.

    Nursing homes may not always be dementia trained, where as dementia homes can get in nursing care, i.e district nursed, OT's, physio's etc.

    Lionel's home has a residential side, mainly for frail elderly and early dementia, and an EMI secure unit. We were self funding and never seemed to get much help when it came to chosing a home.

    Hope you find something suitable.
    Connie

    Carer and Volunteer Moderator

    "Today is as good as it gets" - Lionel, upon diagnosis 2002
     

  4. #4
    What is the difference in a residential and a nursing home in terms of a person's care needs?

    I have found over the years of mum going into respite mum with her Demetria.

    Then comparing a residential elderly person care home . to a register residential dementia care home .

    The residential registered dementia care home can see to my mother care needs more better then a residential elderly person care home.

    As its all progressed, my mother behavior change she lost her social skills so a residential registered dementia can not meet my mother care needs anymore

    So My mother now being sent to a Demetria nursing care home .


    You can ask for an assessment from someone in a memory clinic a consultant to assess your mother care needs, rather then Just taking the advice of a social worker .

    But its up to you .
    Last edited by Margarita; 20-04-2009 at 07:32 PM.
    "You never know how strong you are until being strong is your only option."
    Author: Unknown

    Each person experiences dementia in their own individual way.
     

  5. #5
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    From our experience there are Care Homes with Nursing and Care Homes without nursing. Either one may be registered to accept residents with dementia.

    My dad is in a care home without nursing, but which only takes residents with dementia. He has full help with washing, dressing, shaving, toileting ... and although most days he can feed himself, other residents who cannot are helped with their food.

    I would have a look at the Care Quality Commission website to get a list of homes and then I'm afraid it's down to leg work to visit all the ones you shortlist. If you do find a home, someone from the home should do a full assessment before deciding if they can meet your mum's needs.

    Link to CQC's website:

    http://www.cqc.org.uk/registeredserv...uicksearch.asp

    Good luck.
    Sue

    Former carer and Volunteer Moderator

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  6. #6
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    Thanks Sue, yes i think somewhere which has a dementia facility is the way forward after all. I suppose I just need to understand what needs will be met in the care home and if they match what my mum needs too. We don't have a formal assessment from the hospital yet either, so it's probably best to wait but having said that, I can approach individual homes to to their own assessment and it might be quicker!
     

  7. #7
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    I agree with Sue. You have to go and look and talk to the managers.

    My mum went into an EMI (now called a dementia) Residential Home about 4 years ago due to her AD.

    She is still there even though she now cannot walk or talk or feed herself and is lifted from bed to chair and back to bed. I am happy with the Care mum receives.

    The manager’s policy is that residents can stay till they pass on, as it is now their home.

    I suppose it depends on how many health related complications the person has, as to whether a Nursing Home is necessary.

    Best wishes

    Clive
     

  8. #8
    Another point that you might want to think about - residential homes may be more willing to take someone with dementia if they're not particularly active. While being bedridden may cause a lot of problems when it comes to taking care of someone in their own home, in a residential setting it can be easier to manage that person, because they don't have to worry so much about them wandering of, being disruptive or whatever.
    Jennifer

    Volunteer moderator and former long distance carer.

    “A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.”

    Abraham J. Heschel
     

  9. #9
    Hi Lisa,

    You might want to look at this recent thread that discussed the different types of homes:

    http://forum.alzheimers.org.uk/showthread.php?t=15904

    As this comes up so frequently, I have made a little graphic to use in future which outline the 4 basic types of home, based on the CQC registration categories:



    The most basic type of home is Without Nursing and with residents classified as Old Age Only - Type 1 (my designation only). Many homes termed "residential" are these types of home.

    If someone does not need nursing, but need higher levels of support due to their dementia, then they would need Type 2. This type of home should have things like higher levels of security, more specialist training for staff, etc.

    Type 3, Old Age Only with Nursing isn't one that normally comes into play on Talking Point. However, when we were looking at homes for my mother-in-law, we did see one Type 3 home that felt they could meet her needs as she was only in the early/mid stages of AZ.

    Type 4, Dementia (EMI) with Nursing, are usually associated with the most intense, complex and unpredictable level of need - either from dementia or dementia plus other condtions needing nursing (e.g. management of insulin-dependent diabetes).

    The short answer to your question is to get out there and try and see as many homes as possible, because the categories are quite broad really.

    Also, some homes may be licensed to care for a small, set number of people with dementia - say 6 out of a total population of 30. Those homes may be quite different to one where all 30 places are for people with dementia.

    Some homes have different units which could cover all 4 types of registration and people can move between them as their needs change.

    My mother-in-law is in such a home. She is now in the Type 1 unit (she in on Aricept and scores around 21 on her MMSE). When her needs change, there is a Type 2 unit.

    If she needs nursing care, then it will have to be another home - but having looked fairly extensively a year ago, we have some ideas about what's available (though would always re-visit prior to any re-location).

    Take care,

    Sandy
     

  10. #10
    Hi Lisa,

    As your mother hasn't had a diagnosis yet, and hence hasn't been tried on any medication, there may be a case for an intermediate care placement to see how well she could respond to treatment.

    I have only recently come across this term "intermediate care". It's sort of like a spell of convalescense which could be in a care home.

    It was mentioned in a recent post:

    http://forum.alzheimers.org.uk/showt...ate#post195773

    Take care,

    Sandy
     

  11. #11
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    Sandy,

    Your graphic and your words to describe the various ‘types of care homes’ are the best I have seen thus far!!

    The only thing I would add is caution about the use of the (old favourite) term EMI.

    Why?

    For the simple reason that a person can be ‘Elderly Mentally Infirm’ without there being a dementia in their past or present medical history. Or even in their future. An ‘EMI’ unit may have many residents without dementia, but with seriously ‘challenging conditions’, unrelated to dementia.

    Equally, someone with ‘a dementia’ may not be ‘elderly mentally infirm’.

    The more we use the term EMI, then the more we deny the existence of dementia.

    Dementia must not be crowded under the term ‘elderly mentally infirm’.

    Dementia is Dementia. Young – middle-aged – old. Dementia is Dementia.

    As Terry Pratchett said recently ‘name the demon ... call the demon by its name’. Or words to that effect.

    The term EMI began to be ‘outmoded’ and ‘undesirable’ back in 2002, because it is so enormously misleading. But language changes slowly. And the more that the word Dementia can be placed in the foreground, rather than the background, then the quicker we may achieve progress.

    You may be old-aged/elderly and need to reside in a care home.
    You may be old-aged/elderly and have nursing needs, and so need to reside in a care home with nursing care provision, because of your old-age and your nursing care needs.

    You may be old-aged/elderly and have a dementia and need to reside in a care home.
    You may be old-aged/elderly and have a dementia and have nursing needs, and so need to reside in a care home with nursing care provision, because of your dementia and your nursing care needs.

    Another thing that we have found: if a resident is residing in a care home before any dementia manifests itself, then that care home may be able to accommodate that person.

    But, any care home that is not registered via the CQC as suitable for people with dementia, can only accept a person with a dementia if the Care Home applies for a variation in their CQC registration.

    That has to be a good thing, because it means that there must be suitably dementia-trained staff and suitable staffing ratios.

    .
     

  12. #12
    Hi JPG1,

    Quote Originally Posted by JPG1 View Post
    Your graphic and your words to describe the various ‘types of care homes’ are the best I have seen thus far!!
    Thanks - sometimes I find it easier to process information visually.

    Quote Originally Posted by JPG1 View Post
    The only thing I would add is caution about the use of the (old favourite) term EMI.
    For consistency, I decided to use exactly the terminology used on the CQC search page: http://www.cqc.org.uk/registeredserv...uicksearch.asp

    I don't disagree with your position on dementia being the preferred term.

    Quote Originally Posted by JPG1 View Post
    Another thing that we have found: if a resident is residing in a care home before any dementia manifests itself, then that care home may be able to accommodate that person.

    But, any care home that is not registered via the CQC as suitable for people with dementia, can only accept a person with a dementia if the Care Home applies for a variation in their CQC registration.

    That has to be a good thing, because it means that there must be suitably dementia-trained staff and suitable staffing ratios.
    Well, that is the really interesting question - Can a residential care home only accept someone with dementia if they apply for a variation?

    And what does the term "with dementia" mean in this case? With a diagnosis of dementia but little behavioural signs other than mild memory loss? With no diagnosis of dementia but showing signs of severe confusion, agitation and wandering?

    The reason I mention this, is a recent news item on the Society's web site:

    http://www.alzheimers.org.uk/site/sc...php?newsID=431

    shows that there is a huge gap between the number of people with dementia in care and the places for people with dementia.

    I'm not saying that this is a good thing - clearly it's not. It just highlights the gap between theory and practice at the moment.

    Take care,

    Sandy
     

  13. #13
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    Sandy, I understand why you chose to use exactly the terminolgy used on the CQC search page. Absolutely. The brackets around the term EMI are intended to indicate the old terminology. That’s the way it was explained to me by CSCI as it was then.

    CSCI also said that:

    Any resident already residing in a care home before the advent of dementia may remain in that same care home if the home is able to meet his/her needs.

    CSCI also said that:

    Any care home not registered as being suitable to accommodate and care for dementia can only accept a person with dementia if that same care home applies for a variation in their registration.

    NB. We did not discuss the degrees of dementia. Degrees of dementia do not feature on the CSCI/CQC search pages. Either a care home is registered ‘for dementia’ (their terminology, not mine!) or not.

    Also because we have experience of dementia that went from mild to moderate to severe all within 12 months.

    So, we have always worked along the thought-lines that Dementia is Dementia.

    The staff should be trained to deal with Dementia in all its forms and through all its stages.

    We should not be expected to move our dementia sufferer from care home to care home to care home, depending on the progress of their dementia.

    Unless and until those ‘degrees of dementia’ are announced and recognised in the registration as declared on CQC of care homes deemed suitable for dementia sufferers. Why should we torment our relatives with dementia, unless there is a very very good reason? And lack of staff training is not a good enough reason.

    Yes, there is a huge gap between the number of people with dementia in care and the places ‘for’ people with dementia. Which you could turn about and ask: how many care homes are accepting dementia-sufferers to their care homes without being able to provide the necessary care and the trained staff to provide that care.

    .
     

  14. #14
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    Well we've had some feedback from the consultant re mum. She had a CT scan today and they said that they could not actually say that she had dementia from the results but that it provided a good clue. She apparently has age related deterioration in the vessels so this could mean vascular dementia.

    She is going to be assessed by a multi-disciplinary team before a diagnosis/care plan can be put in place and they are going to keep her in hospital until then which is a relief.

    In the meantime, I am phoning the hospital every day to get updates, liaising with the social worker and arranging to visit care homes so that we are ready for when she is discharged. Based on the info given so far, we are looking at care/residential homes with dementia facility. Whether she goes straight there from hospital or we try her at home with her carer going in 3 times a day first, i don't know yet. It all depends on the outcome of the hospital assessment.

    I am starting to see a little glimmer of light at the end of the tunnel........but it's a very LONG tunnel and i don't want to speak too soon in case the light suddenly goes out!!

    Thank you to all who have contributed your support over the past few days. This forum has been an absolute blessing.

    XxX
     

  15. #15
    She is going to be assessed by a multi-disciplinary team before a diagnosis/care plan can be put in place and they are going to keep her in hospital until then which is a relief.
    yes that must be such a relief for you, keeping your mother in hospital till care plan sorted out .sound like you done really well in getting it all sorted out . Well done .

    She apparently has age related deterioration in the vessels so this could mean vascular dementia.
    I never new that age related deterioration in the vessels in the brain could give someone having vascular dementia.

    As the Alzheimer's Society say that a Demetria is not due to natural part of aging .
    Last edited by Margarita; 22-04-2009 at 01:05 AM.
    "You never know how strong you are until being strong is your only option."
    Author: Unknown

    Each person experiences dementia in their own individual way.
     

 

 

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